Every day a barrage of HIV research is published and presented around the world. Even if you were to read all the journal articles and research meeting coverage related to HIV, how should you evaluate the importance of individual studies? That's when it helps to know someone who is himself knee-deep in the research.

Dr. David Wohl is a researcher and clinician at the University of North Carolina, and he's also an expert in our "Ask the Experts" forums. For years now, Dr. Wohl has been writing our year-end review of the top HIV medical stories for health care professionals on our sister site The Body PRO.

Dr. Wohl has the unique ability to put the advances of HIV medicine in perspective, and he does so with humor and with wisdom. But most importantly, he tries to make the material accessible to everyone. If you're interested in discovering the very latest in cutting-edge HIV research, read or listen to our interview, or if you just want the nitty gritty, take a look at our summary.

Welcome, Dr. Wohl. Tell me, what did you think was the number one HIV research study of 2007?

Advertisement

There were actually a bunch of important research studies. The big story is that there are new drugs, and they work really well. In 2007 there were a few different studies of new drugs that are opening up a whole new opportunity for people with HIV infection.

I've heard people say that it's just like it was in 1996, when HAART [highly active antiretroviral therapy] was approved. There's a lot of hope now in the air because of all these new drugs.

I think the difference between 1996 and 2008 is that we're smarter. That doesn't mean we're smart, it just means we're smarter. I think we've learned a lot from our mistakes, from the science that's gone on, and from our patients. What we're seeing now is a new day in HIV care, where there are some more options, and they're not what I call "me too" drugs. They're not retooled versions of old drugs. These are actually new compounds that can work against the virus. I don't know if it's completely analogous, but in many ways it is like 1996 for someone who hasn't had very much in the way of options, but now does and is really committed to taking his or her therapy. We have to remember that a person can have all the new drugs in the world and they can all be potent, but unless the person is committed to taking his or her medicines and taking them as directed, it doesn't matter how novel and new or potent it is.

Can you list these new drugs?

There are several of them. The first one that I want to mention is Isentress [raltegravir, MK-0518].1,2 This is a totally new drug in a new category of drugs. It works on an enzyme called integrase, which was never targeted before. It works within the HIV virus to keep the HIV virus from making more copies of itself.

Another one is called Selzentry [maraviroc, Celsentri].3,4 Selzentry is a very new type of drug; it blocks the entry of HIV into the cell by blocking a receptor that the virus needs to get into the cell. Very exciting.

These are four really exciting new drugs that are making a tremendous difference for people who have experience with HIV drugs and have resistant virus.

"One thing we're seeing consistently throughout these studies is that the more new drugs that are active against your virus, the better, and the greater the chance that your viral load will become undetectable."

There are really good data to show that, in people who are HIV infected and who have resistant virus, each of these drugs -- in combination with other drugs -- can get their viral load undetectable. One thing we're seeing consistently throughout these studies is that the more new drugs that are active against your virus, the better, and the greater the chance that your viral load will become undetectable. This is true even if you have dripping red genotypes that show so much resistance that nothing else is predicted to work.

What we're seeing is that when you have two, or possibly even three, newer agents that work against your virus, it works great. Before we had these newer medicines, there just wasn't a critical mass. There weren't enough new medicines to craft a regimen that was likely to work in people whose HIV was already resistant to a lot of HIV medications. With these newer drugs, there's now more to pick from. Two, or even three, active medications should work against a person's virus. It opens up tremendous new opportunities for people who, before these drugs came about, didn't have any opportunities.

Are these drugs going to be used at all for people just starting therapy?

There's always an interest among the manufacturers of drugs like these to try to get the use of their drugs to expand beyond one niche. A drug comes out that's used in what we call salvage therapy -- meaning people who need new drugs to rescue them because they have resistant virus and the other drugs aren't working -- and then the manufacturer tries to get it to work in a treatment-naive person. "Treatment-naive people," that's our jargon for people who've never been on HIV therapy before. It makes sense, because then the drug manufacturer gets a broader market for its product. In every single one of these cases, there's some interest in using these medications early on.

For different drugs, there's a different amount of data supporting them. We know that there's a big interest in using Prezista early on, because it's a protease inhibitor and we do use protease inhibitors early in HIV therapy, including as initial therapy.8 That's a no-brainer.

I think there certainly is interest in using more novel agents such as Selzentry and Isentress early on, and studies are ongoing of those medicines.9 For Selzentry, there was one study that looked at it against Sustiva early in HIV therapy.10 It didn't do as great as Sustiva, but it looked pretty decent. I think it's encouraging.

Intelence is a drug that people will also look at for initial treatment. The answer to your question is definitely yes.

Let's move on to the number two most important study of 2007.

Is this the dawn of a new era in HIV care? I think arguably it is. But one thing we're still dealing with is too many people are coming in too late to HIV care.

There was a very important study done by the Johns Hopkins group.11 The investigators looked at the immune status of people presenting for care in their clinic in Baltimore. The bottom line was that over time, we really haven't seen improvements in this. In fact, if anything, we're seeing people come in with lowerCD4 cell counts. There are data that have been presented before that indicate that the average T-cell count of people presenting for care in the United States is under 200.12 It's about 187.

What the Hopkins group was able to do was to look at their patient population over different chunks of time.11 They found that, again, people are entering care who have never been on HIV therapy before, with decreasing CD4 cell counts.

This is really concerning, because it means people are showing up late. It means people are not getting tested earlier in the course of their HIV infection. We know that people who start therapy at lower CD4 cell counts have a greater risk of side effects, and may not respond as well as people who have higher CD4 cell counts.

So it's very concerning. It shows that we are not doing a good job of offering HIV testing and having people utilize HIV testing on a more regular basis.

So this is a failure in HIV prevention?

I think this is a failure in HIV detection.

Detection?

Certainly there is, taking a step back, a failure in prevention and that's why people are getting infected. But what we're seeing here is that we are not doing a very good job of diagnosing infection as evidenced by the fact that:

Twenty-five to 30 percent of people with HIV in this country do not know they're HIV infected,13 and

People who are diagnosed are getting diagnosed pretty late in the course of their disease.

That has implications not only for that person's health, but also for the public health. That means under-diagnosis leads to people having sex with people and possibly transmitting their virus unbeknownst because they didn't know they were HIV infected.

I think there are a few different dimensions here that are very concerning. In this analysis, it's very interesting that being older, being male, and being African American were independently associated with having a lower CD4 cell count on presentation. That tells us that not only is there a problem, but that there's a problem among certain subpopulations that's very concerning.11

Did the researchers suggest anything?

The glaring neon light shining here is that we should be doing more testing. The CDC [U.S. Centers for Disease Control and Prevention] came out with some important recommendations, saying that anyone who's in medical health care should be tested for HIV.14

I think that's really important. I think we should have routine HIV testing. You visit your doctor for your annual physical and the doctor offers you an HIV test. If you have risk behaviors, the doctor should continue to offer you that regularly.

I think we're under-testing people, and we're not using our health care system as a tool. It's a very important tool in HIV prevention when used to detect people with HIV. We've done it with pregnant women; pregnant women know that when they come into perinatal clinics, they're going to be offered HIV testing. We need to have that happen for people coming in to get their blood pressure checked, their cholesterol checked.

Comment by: William
(London, UK)
Wed., Jan. 13, 2010 at 5:38 am EST
My name is williams, I am 35 years old male from London, UK.
I do not have HIV but i am very sad to learn that many people are dying of this disease. I can help or support someone who have this disease in any way that I could. I can also be your best friend or even lover.......
I am looking for good friends from all over the world. It doesnt matter if you have HIV or not.
I am a good Christian and do not care about age, race, color or religion as we are made by the same God...
I HATE Lies, injustice, terrorism and discrimination..
If you wanna be my friend send me an email with the subject: FRIENDSHIP.
Peace and Love to you all..
This is my email address: williampeaston@yahoo.com

Comment by: Priscillar
(South Africa, Johannesburg)
Thu., Nov. 20, 2008 at 10:49 am EST
I was diagnosed last year, 2007, with a CD4 of 59. Now I am at 550, taking Truvada and Stoctrin. What are my chances of opportunistic diseases, and toxicities? I need to be linked with a friend in SA.

Comment by: jim
(alaska)
Tue., Oct. 7, 2008 at 2:12 am EDT
i get the body regularly in e-mail and I am so thankful to all the wonderful doctors that contibute. I found out I had AIDS when I was hospitalised in 2000 with pml encephalitis and thank god for great doctors and great medicines i am alive to write this and i am am doing quite well. my past doctors whom i have kept n contact with in oregon are amazed. i was paralyzed on the right side of my body and they told my mother i would not survive the week. now i am a truck driver driving big semi's! People, get tested. If applicable, get on meds and PLEASE do not miss any doses. i say this from the bottom of my heart! You can e-mail me at willow444@msn.com. have a wonderful life! GET TESTED!!!!! Thank you again wonderful doctors!!!!!!!

Comment by: simone
(Rosebud,SD)
Tue., Sep. 2, 2008 at 12:42 pm EDT
I'm working to get the Native American people to get tested on the Reservation we have no testing. I'm working to collaborate with IHS to start testing I'm with the CHR Program. The hardest part is trying to get the people to get tested. I'm going to do the best I can to get them tested. I just wanted to let people know that their is a problem getting people tested everywhere.

Comment by: lashawnaMon., Aug. 11, 2008 at 8:46 pm EDT
i think people really need to understand what sex is. too many people think it's ok to have unprotected sex when it is not ok. if you are going to do something with someone, wrap it up please. be the smarter person. that goes for straight people and gay people. get it together people! life is too short, please do not make it shorter.

Comment by: jerry moralesThu., Jul. 31, 2008 at 1:33 pm EDT
I have a comment for dissidence 101, you weren't to concerened about vaccine success when you became infected and these drugs do seem to be keeping me alive. So bravo for the new drugs. I'm on Prezista and Isentress and celebrate their arrival. I'm sorry life doesn't seem as rosey for you.

Comment by: JasonMon., Jul. 7, 2008 at 7:16 pm EDT
I read that CDC predicts that if someone is positive less than four months that they can eliminate the virus from the body (with meds) within an average of 7.7 years. Is this true?

Comment by: wamSat., Jul. 5, 2008 at 12:49 pm EDT
Hi Ezekiel Otieno where are you in Kenya. I am also positive living in U.K detected about 9 mths ago single mum of three. You can email me at nan.sa08@hotmail.com

Comment by: Gideon LawalMon., Jun. 30, 2008 at 9:34 am EDT
Well am kinda new to this well. i lost my brother to this disease. right now the last time i check my status i was positive too and then my cd4 count is 375 and am still on oi. i need a friend from Europe and USA and anywhere in the world to help pass through this hard time right now am having stomach pain and headache.. here is my email: gideon080seyi@yahoo.com

Comment by: dorcasThu., Jun. 26, 2008 at 8:28 am EDT
doc.a big well done 4 d enlightenment.it goes a long way to give hope and encouragement to all the infected.its a therapy.hiv is a fundamental right and not a disease that needs to be adhered to.thanks

Comment by: hilaryWed., May. 28, 2008 at 6:30 pm EDT
i have just found out my wonderfull nephew is HIV. Am so upset, my world has came crashing down. Thank God i can read positive stories. i can only pray he will outlive me. This happens to other familes not mine or so i thought. feel so ashamed. i thought HIV was AIDS I'm learning, however we all pretend it is not happening. i pray for a cure.

Comment by: TEDDYThu., May. 15, 2008 at 9:05 pm EDT
Good job, but we need drugs that you could take once a month,any possibility? I know the pharmaceutical companies will frown over this as it will make volumes on profitable

Comment by: johnkWed., May. 14, 2008 at 12:55 am EDT
What a smart, sharp overview! I too think the plethora of new interesting drugs is the story of the year. They have given me lots of hope as I've undetectable for the first time in 15 years! HIV medicine has made such strides. I'm one lucky man!

Comment by: John morseSun., May. 11, 2008 at 10:42 pm EDT
I was diagnosed with HiV at age 70! I am currently enrolled in a trail 96 week study for HIV naieve people. I am taking MK-0518 (or Placebo) Efavirenz (or placebo) and Truvada. within three months of taking the medications My viral load was undetectable and CD was up to 415 from 275! I have been on this program for a year now.

Comment by: dissidence101Sun., May. 11, 2008 at 10:22 pm EDT
That's just simply amazing that the biggest story of the whole year is "THERE'S MORE DRUGS". Gezze. I have a better one. How about and to the dismay of researchers, Merck's v520 complete and utter vaccine trial failure?

Comment by: NoniSat., May. 10, 2008 at 3:20 pm EDT
I started treatment in 2003 with CD4 of 8.I was on d4t, 3tc. I experienced loss of fats in hips and butt and changed to azt. Problem is i always worry about what if it doesnt work because in S.A we have only limited (2) regimens available. Are we S.A allowed to have or access these plenty of meds available in U.S.A and other countries? If so how do you access them?

Comment by: ezekiel otienoSat., May. 10, 2008 at 9:10 am EDT
this website has given me a lot of strength.Through this I've learnt that i can live long enough than the seven years since i knew my status and i'm not alone.
I'm requesting this website to connect me one person living positively in Europe or Asia. I am from Kenya.

I would like to say how happy I am for all that have found their meds to work and they are doing great, Thank God for that, because He is always looking out for us all the time. I lost my brother to Hiv/Aids last year because he didn't and wouldn't seek treatment until it was too late. I miss him very much and I also have another brother who is Hiv positive as well. He is keeping up with his doctor's visits and taking care of himself. Please know that there are programs out there that can help you if you are sick. Don't wait! Seek help right away and remember that knowledge is power. God bless you all.

Comment by: Dr. Elizabeth MwanukuziWed., May. 7, 2008 at 10:20 am EDT
It is very interesting to note that the problem of late diagnosis is not limited to resource poor countries but what is particularly challenging to us in Africa is the poor accessibility of care and treatment facilities for rural communities because of poverty and poor travel intfrastructure

Comment by: A AL YAZOURYWed., May. 7, 2008 at 10:02 am EDT
THANK U GUYS FOR THIS GEART WEBSITE,THANK U VERY MUCH DOC FOR YOUR GREAT EFFORTS, I SUGGEST HIV TESTING FOR EVERY PERSON ONCE THEY ARE IN THE PROCESS OF GETTING ENSURACE CARD SO THIS WILL MAKE IT MORE EASY FOR EARLY DETECTION FOR THE VIRUS AND EARLY HELP AND BETEER PROGNOSIS, GOD BLESS U ALL.

Comment by: Akan ItukWed., May. 7, 2008 at 9:33 am EDT
A major problem with the HIV pandemic is that most folks is yet to come in terms with the reality. They "believe" they are uninfectable and as such need not to go for HIV screening. It is not until HIV is succesfully demystified, social immunization will not be achieved.

Comment by: AMALWed., May. 7, 2008 at 7:46 am EDT
THANKS DOC FOR YOUR WORK, PRAYERS FROM THE HEART FOR ALL THE POZs TO GET WELL SOON. IT'S A MATTER OF TIME, ONCE YOU R IN THE ACCEPTANCE STAGE YOU CAN LIVE NORMALLY. THANKS

Comment by: Brown Family FoundationTue., May. 6, 2008 at 9:26 pm EDT
This article was very informative. Our organization promotes HIV Prevention and Detection. We've established a program called "Sisters Can We Talk". This program consist of panel discussions and small group sessions dealing with the subject of HIV and AIDS. We utilize local organizations to provide testing at each event.

I've been poz for over 18 years now, and can say with confidence the hiv bug is a manageable disease.

Reason for writing is this: Fat has been stripped from my arms, legs, and butt. If it would help, I am quite able to give you the litany of all the drug regimens between start to the present. In summary first drug was AZT in 1992, when CD4 was 290. Currently I am taking Isentress, Aprivus, Norvir, and Epzicom and my CD4 is 770, wowee ! and VL is und.

For all I know, it seems to be a metabolic puzzle, and fortunately, no facial wasting, thank God.

(Please note: Your name and comment will be public, and may even show up in Internet search results. Be careful when providing personal information! Beforeadding your comment, please read TheBody.com's Comment Policy.)

The Body is a service of Remedy Health Media, LLC, 750 3rd Avenue, 6th Floor, New York, NY 10017. The Body and its logos are trademarks of Remedy Health Media, LLC, and its subsidiaries, which owns the copyright of The Body's homepage, topic pages, page designs and HTML code. General Disclaimer: The Body is designed for educational purposes only and is not engaged in rendering medical advice or professional services. The information provided through The Body should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you have or suspect you may have a health problem, consult your health care provider.